Taking Aim at Gun Violence: ACP Builds Coalition

Can 36 medical, legal, and community organizations defeat the gun lobby?

BOSTON -- Every time a physician treats a gunshot victim he or she should develop a discharge plan that includes a mental health evaluation and counseling as needed.

Failing to do so is practicing bad medicine, said JudyAnn Bigby, MD, former secretary of Health and Human Services of the Commonwealth of Massachusetts.

Bigby, who spoke at an American College of Physicians press briefing on gun violence, noted that it is standard medical practice for physicians to refer "attempted suicides for mental health evaluation," yet common practice for gunshot victims is to "patch them up, and send them home."

The ACP was promoting its coalition of 36 medical, legal, and community organizations, all of which have now signed on to a document titled "Firearm-Related Injury and Death in the United States: A Call to Action from 8 Health Professional Organizations and the American Bar Association."

The 28 new co-signers, which include the American Academy of Neurology, the American College of Chest Physicians, and the American Psychological Association, added their names after the statement was published in February 2015. The original eight-member coalition included the ACP and the ABA as well as the American Academy of Pediatrics, the American Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, American College of Surgeons, American Psychiatric Association, American College of Emergency Physicians, and American Public Health Association.

ACP Executive Vice President Steven Weinberger, MD, said a number of other medical groups -- including the American Medical Association -- are considering signing on but are awaiting review and approval from their governance bodies.

Weinberger said the support from the ABA was very significant since it had addressed Second Amendment concerns, verifying that "these recommendations do not violate any Second Amendment rights."

Asked about next steps, Weinberger said the coalition wants a public health campaign similar to campaigns used to curb drunk driving in order to build public support.

MedPage Today asked if the coalition sought a meeting with the National Rifle Association. Weinberger replied it had not, noting that the NRA did not appear to be interested in a "professional discussion." He added, "When the original paper came out, they [the NRA] posted something on their website that was an acknowledgement but not a respectful analysis."

Weinberger also pointed to the NRA's efforts to block the nomination of Vivek Murthy, MD, as U.S. Surgeon General "because Dr. Murthy said gun violence was a public health concern."

Ali S. Raja, MD, MBA, MPH, vice chairman of the department of emergency medicine at Massachusetts General Hospital, agreed with Bigby's assessment of gun violence as a public health issue and he illustrated that stance with two cases from his own practice.

"I spent about 10 or 12 minutes with this man -- and I know that doesn't sound like a lot, but it is a lot more than I normally spend," he said. During that time the man told Raja that he was a former Marine who had "an ex-GI life insurance policy."

The man, Raja said, had been unemployed for some time and had come to believe that he could solve his family's economic problems by killing himself so that his wife could cash in that policy.

Raja said he asked the man if he had a gun and if the gun was loaded.

The man said he did have a gun "and usually lately I've kept it loaded because I was worried that I would talk myself out of it [suicide]." Raja signed a commitment order that kept the man in the hospital for 72 hours, after which the man was transferred to McLean Psychiatric Hospital, where he is now receiving outpatient care.

"Yesterday, I checked up on him because its been 2 weeks now and the case notes indicate that the man is doing better," Raja said.

Raja's second case demonstrated what may be a more common scenario. He was called in to treat a young man who had been shot in the chest. His team performed a thoracotomy, but the patient died.

When he told the patient's mother that her son had died, "She said, 'Are you sure?'"

The young man had been shot a year earlier and at that time a thoracotomy was performed. "The mother had been told [then] that her son would die, but he had survived."

When Raja returned to the emergency department he looked again at the patient and saw the scar from the earlier thoracotomy.

The man had been patched up and, Raja said, sent out to face the same risk again.

Another major problem, Bigby said, was the ease with which mentally ill patients had access to guns but did not have access to good mental health services. "This population, these people are the most severely mentally ill patients -- they are the canaries in the mine for mental health care. If, as a society, we can't get care for them, how can we address care for the large population of less severely ill patients?"

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